1.
Value of nutrition support therapy in patients with gastrointestinal malignancies: a narrative review and health economic analysis of impact on clinical outcomes in the United States.
Pimiento, JM, Evans, DC, Tyler, R, Barrocas, A, Hernandez, B, Araujo-Torres, K, Guenter, P, ,
Journal of gastrointestinal oncology. 2021;(2):864-873
Abstract
Malnutrition, particularly under-nutrition, is highly prevalent among adult patients with a diagnosis of gastrointestinal (GI) cancer and negatively affects patient outcomes. Malnutrition is associated with clinical and surgical complications for patients undergoing therapy for GI cancers and the costs associated with those complications is a high burden for the US health system. Our objective was to identify high-quality evidence for nutrition support interventions associated with cost savings for patient care, followed by a complex economic value analysis to project cost savings for the US health system. A narrative literature search was conducted in which combined keywords in the areas of therapeutic nutrition (nutrition, malnutrition), a specific therapeutic area [GI cancer (esophageal, gastric, gallbladder, pancreatic, liver/hepatic, small and large intestine, colorectal)], and clinical outcomes and healthcare cost, to look for nutrition interventions that could significantly improve clinical outcomes. Medicare claims data were then analyzed using the findings of these identified studies and this modeling exercise supported identifying the cost and healthcare resource utilization implications of specific populations to determine the impact of nutrition support on reducing these costs as reflected in the summary of the evidence. Eight studies were found that provided clinical outcomes and health cost savings data, 2 of those had the strongest level of evidence and were used for Value Analysis calculations. Nutrition interventions such as oral diet modifications, enteral nutrition (EN) supplementation, and parenteral nutrition (PN) have been studied especially in the peri-operative setting. Specifically, peri-operative immunonutrition administration and utilization of enhanced recovery pathways after surgery have been associated with significant improvement in postoperative complications and decreased length of hospital stay (LOS). Utilizing economic modeling of Medicare claims data from GI cancer patients, potential annual cost savings of $242 million were projected by the widespread adoption of these interventions. Clinical outcomes can be improved with the use of nutrition interventions in patients with GI cancers. Healthcare costs can be reduced as a result of fewer in-hospital complications and shorter lengths of hospital stay. The application of nutrition intervention provides a positive clinical and economic value proposition to the healthcare system for patients with GI cancers.
2.
African American Participation in Oncology Clinical Trials--Focus on Prostate Cancer: Implications, Barriers, and Potential Solutions.
Ahaghotu, C, Tyler, R, Sartor, O
Clinical genitourinary cancer. 2016;(2):105-16
Abstract
In the United States, the incidence and mortality rates of many cancers, especially prostate cancer, are disproportionately high among African American men compared with Caucasian men. Recently, mortality rates for prostate cancer have declined more rapidly in African American versus Caucasian men, but prostate cancer is still the most common cancer and the second leading cause of cancer deaths in African American men in the United States. Compared with Caucasian men, prostate cancer occurs at younger ages, has a higher stage at diagnosis, and is more likely to progress after definitive treatments in African American men. Reasons for racial discrepancies in cancer are multifactorial and potentially include socioeconomic, cultural, nutritional, and biologic elements. In addition to improving access to novel therapies, clinical trial participation is essential to adequately establish the risks and benefits of treatments in African American populations. Considering the disproportionately high mortality rates noted in these groups, our understanding of the natural history and responses to therapies is limited. This review will explore African American underrepresentation in clinical trials with a focus on prostate cancer, and potentially effective strategies to engage African American communities in prostate cancer research. Solutions targeting physicians, investigators, the community, and health care systems are identified. Improvement of African American participation in prostate cancer clinical trials will benefit all stakeholders.
3.
Zinc as a possible treatment for tinnitus.
Coelho, CB, Tyler, R, Hansen, M
Progress in brain research. 2007;:279-85
Abstract
Zinc is an essential trace element present in all organs, tissues, fluids, and secretions of the body and it is widely distributed in the central nervous system, including the auditory pathway in synapses of the VIII nerve and in the cochlea. Zinc is an essential component of Cu/Zn superoxide dismutase (SOD) and in certain enzymes and it is important for proper function of the immune system. Three possible mechanisms have linked zinc to tinnitus; cochlear Cu/Zn SOD activity, synaptic transmission, and depression. Evidences in the literature suggest prevalence rates of zinc deficiency in individuals with tinnitus from 2 to 69%, affecting elderly individuals more frequently. Four among five small studies indicate that administration of zinc has a beneficial effect on tinnitus but these results still have to be confirmed in clinical trials with larger samples using a cross-over design, validated tinnitus handicap questionnaires, measurements of tinnitus magnitude, and accessing the coexistence of other symptoms such as depression, phonophobia, and hyperacusis.